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Date available to start |
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How did you hear about us? |
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Last Name |
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First Name |
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Middle Initial |
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Street Address |
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City |
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State |
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Zip Code |
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Telephone Number |
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AlternateTelephone Number |
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If hired, can you provide proof of US citizenship, or verification of your legal right to work in the United States? |
Yes: No: |
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If not a US citizen, please insert your alien registration number |
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Are you at least 18 years of age? |
Yes: No: |
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Educational Background |
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Grade School (Highest completed) |
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High School (Highest completed) |
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College / Tech (Highest completed) |
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Grad School (Highest completed) |
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Military Service |
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Service Branch |
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Years Served |
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Senesco Attendance Statement |
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Senesco expects a high
attendance rate of employees. Applicants should be aware of the
following:
*Senesco's regular (full-time) work week is Monday through
Thursday, 6:30 AM to 5:00 PM and Friday is 6:30 AM to 3:00 PM, for the
first shift (mandatory 48 hour week). The second shift is Monday through Thursday, 4:45 PM to 3:15 AM and Friday 2:45 PM to 11:15 PM. Hours will vary. Office hours 8:00 AM to 5:00 PM
*Saturday and Sunday are optional workdays, as required by the
company.
*The Company reserves the right to modify the work week without
notice. |
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Can you meet the required attendance of your position? |
Yes: No: |
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Will adequate and reliable transportation be available to you? |
Yes: No: |
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Job Interest |
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What position are you applying for? |
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Type of work preferred: |
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Expected Salary |
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Are you available to work all shifts? |
Yes: No: |
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Preferred shift: |
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Skills and Qualifications |
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(Check all that apply) |
Blue Print Reading |
Brake Press Oper. |
CNC Plasma Oper. |
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Forklift Oper. |
Oxy Fuel Cutting |
Pipe Fitter |
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Rigger |
Ship Fitter |
Theodolites |
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Crane Oper. |
Welder |
Computer Skills |
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T/R |
Stick |
PC |
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Overhead |
Fluxcore |
MAC |
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Crawler |
Mig |
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Subarc |
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Computer Programs (Please List) |
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Other Skills (Please List) |
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Do you know and understand the physical requirements of the position you are applying for? |
Yes: No: |
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Do you know and understand the skill and training requirements of the position? |
Yes: No: |
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Are you able to meet these requirements? (Note: employees will be subject to a physical review and/or exam.) |
Yes: No: |
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Employment History |
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Current or Most Current
Position |
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Employer name |
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Position held |
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Employer Address |
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Employed from: (Date) |
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Employed to: (Date) |
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May we contact this employer? |
Yes: No: |
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Supervisor's name |
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Supervisor's phone number |
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Salary / Hourly rate |
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Average hours worked weekly |
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Reason for leaving |
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Previous Position 1 |
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Employer name |
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Position held |
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Employer Address |
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Employed from: (Date) |
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Employed to: (Date) |
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May we contact this employer? |
Yes: No: |
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Supervisor's name |
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Supervisor's phone number |
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Salary / Hourly rate |
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Average hours worked weekly |
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Reason for leaving |
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Previous Position 2 |
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Employer name |
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Position held |
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Employer Address |
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Employed from: (Date) |
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Employed to: (Date) |
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May we contact this employer? |
Yes: No: |
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Supervisor's name |
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Supervisor's phone number |
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Salary / Hourly rate |
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Average hours worked weekly |
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Reason for leaving |
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Previous Position 3 |
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Employer name |
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Position held |
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Employer Address |
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Employed from: (Date) |
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Employed to: (Date) |
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May we contact this employer? |
Yes:
No:
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Supervisor's name |
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Supervisor's phone number |
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Salary / Hourly rate |
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Average hours worked weekly |
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Reason for leaving |
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Previous Position 4 |
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Employer name |
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Position held |
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Employer Address |
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Employed from: (Date) |
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Employed to: (Date) |
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May we contact this employer? |
Yes:
No:
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Supervisor's name |
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Supervisor's phone number |
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Salary / Hourly rate |
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Average hours worked weekly |
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Reason for leaving |
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Remarks |
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Senesco statement of working conditions |
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Compliance with company guidelines and policies
I understand that as an employee of Senesco Marine, LLC I will be expected to comply with all stated company policies. The company will provide me with a handbook of work-related procedures, standards, policies and directions that conform to state and industry standards.
I understand that my failure to comply with company work and safety guidelines could cause injury to myself, to others, or to company equipment. I understand that my active, ongoing compliance with all company policies and procedures is a condition of my employment.
I HEREBY STATE THAT ALL INFORMATION CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AT Senesco Marine, LLC IS BOTH TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AM AWARE THAT THE FALSIFICATION OF THIS APPLICATION OR THE OMISSION OF COMPLETE INFORMATION WILL RESULT IN DISQUALIFICATION, OR UPON DISCOVERY, TERMINATION OF EMPLOYMENT.
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I have read and understand all of the above information |
Yes: No: |
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Job Applied For: |
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Senesco Marine, LLC STATEMENT OF WORKING CONDITIONS
BAR OF CLAIMS
NOTICE:
Section 28-35-57.1 of the Rhode Island Workers Compensation Law specifies that any employee who falsifies information concerning his or her ability to perform the essential functions of a job, without reasonable changes in the job’s requirements, may be barred for two (2) years from making or collecting for a workers’ compensation claim for any injury resulting from an inability to meet the essential job demands.
AFFIDAVIT:
I hereby attest that I am physically and mentally capable of performing the essential job duties of the above position for which I have applied. I further attest that I have no need for changes or adjustments in the essential duties of the job in order to allow me to meet the demands of the position.
I attest to the above, having reviewed the essential job functions of the attached job description.
Job requirements and workplace conditions
I understand that as an employee of Senesco Marine, LLC, I may be assigned to perform various tasks involving metal fabrication, product assembly, and support. I understand that personal health risks normally associated with shipyard heavy manufacturing and assembly exist throughout the Company. Potential hazards could consist of welding arcs, fumes, grit sparks, metal particles, moving vehicles, moving equipment, and chemicals. As part of my shipyard orientation and environmental, safety, and health training, I will be provided with the knowledge and procedures that I must use to protect myself from any and all hazards in the work environment. I will participate in specialized ESH training as required by my job.
I understand that I may work in open air or in buildings that are weather-protected and ventilated, but not heated or cooled except as required in specific workstations. Some jobs that I perform may require me to be near motor vehicles, railroad tracks, overhead and stationary cranes and forklifts. I understand that my workstation may be located on the waterfront, and may require me to work on or over the water. Senesco Marine LLC will provide me with PPE as required by regulation so that I am able to perform my job safely.
I may be required to enter a confined space that requires special agility. I may work under artificial lighting conditions. I may work at stations where I have to stand, crouch, and kneel for long periods of time. I may work with computers, hand tools, and powered tools that could cause stress to muscular and skeletal body parts. I will receive specialized training by the ESH department or my supervisors as required when using specialized tools and equipment.
I understand that my job could include the lifting of weight between 50 and 75 lbs. In lifting, I understand that I should always keep my back straight and lift with my legs. The object that I lift must be kept as close to my body as possible. It is my responsibility to lift within my capabilities. If I am tasked to lift an object that is beyond my capability, I must notify my supervisor to obtain assistance or use a material handling device – such as an overhead crane or counterbalanced fork truck if I am licensed. In the course of my duties I may be required to walk a combined distance of a mile or more each day. In order to access work areas, my job may include climbing and working on stairs, ladders, scaffolding or similar devices.
I understand that Senesco Marine, LLC is a heavy metal fabricator and that heavy equipment will be in use. This equipment may be located in permanent locations, or it may be mobile and moving throughout the facility. I understand that the improper use of heavy equipment can pose a safety hazard. I understand that I will not operate any equipment at Senesco Marine, LLC unless I am licensed and / or properly qualified. I will only operate the equipment according to the manufacturer’s guidelines and only in a safe manner.
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I have read and understand all of the above information |
Yes: No: |
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Safety equipment and clothing
Senesco Marine, LLC will establish engineering methods and devices to reduce hazards potentially caused by welding arcs, fumes, grit, sparks, and metal. Protective devices may include screens, extractors, signs, and covers.
Senesco Marine, LLC will supply personal protective equipment (PPE) to all employees according to regulations established by OSHA. Certain types of PPE such as clothing that touches the body may or will be the responsibility of the employee to obtain at their expense. In general, PPE that is supplied by Senesco Marine LLC will be replaced when it becomes worn or unserviceable.
Hard hats, safety shoes, and goggles are the standard PPE devices that will be worn by all employees with exceptions that are identified by the ESH department. Additional PPE will be worn as required to protect against the hazard being performed. All PPE is worn based on the Senesco Marine, LLC job hazard analysis.
I understand that following company dress codes, environmental, safety, and health procedures, policies, and guidelines are essential for my personal safety, the safety of my coworkers, and the preservation of company equipment.
DRUG-FREE WORKPLACE AGREEMENT
Senesco Marine, LLC is committed to providing a safe, healthy, and positive workplace for its employees. It is Senesco Marine, LLC’s belief that the use of alcohol or controlled substances in the workplace can seriously increase the risk of an employee’s causing harm to him or herself and to co-workers, or result in behavior that goes against Company policies that protect employee welfare and satisfaction.
I understand that, for this reason, Senesco Marine, LLC takes a strong stand against the presence and improper use of alcohol and controlled substances (prescribed or un-prescribed) in the workplace. I understand that reporting to work under the influence of controlled substances, as well as the use, sale, purchase, or manufacture of these substances on SENESCO property will lead to immediate disciplinary action, up to and including termination of employment.
While these policies must be enforced for my own safety and that of my co-workers, I understand that Senesco Marine, LLC also recognizes the abuse of alcohol and controlled substances as an illness, and a major health problem. If I am concerned about drug and alcohol use, I understand that I can seek [confidential] advice and information about rehabilitation and counseling from the Employee Assistance Program, or through my healthcare provider.
EMPLOYMENT “at-will”
understand that my employment at Senesco Marine, LLC is “at will”. My services at Senesco Marine, LLC may be terminated at any time. I have read and understood the above information and statements, and I agree to act in accordance with them.
I have read and understood the above statements. If hired by Senesco Marine, LLC, I understand that my cooperation with the Drug-Free Workplace Policy will be a condition of my employment. I also understand the above statements relating to company policies, and I agree to act in accordance with them.
AUTHORIZATION TO RELEASE INFORMATION
I have made application for employment with Senesco Marine, LLC. I authorize my former employers to provide any information regarding my employment. I hereby release them from any damage whatsoever for issuing same. |
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I have read and understand all of the above information |
Yes: No: |
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May we contact your present and previos employers? |
Yes:
No:
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